Provider Demographics
NPI:1184025983
Name:MIDDLEBURY AMBULANCE ASSOCIATION INC
Entity Type:Organization
Organization Name:MIDDLEBURY AMBULANCE ASSOCIATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-376-3831
Mailing Address - Street 1:11747 ROUTE 287
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY CENTER
Mailing Address - State:PA
Mailing Address - Zip Code:16935
Mailing Address - Country:US
Mailing Address - Phone:570-376-3831
Mailing Address - Fax:570-376-2370
Practice Address - Street 1:11747 ROUTE 287
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY CENTER
Practice Address - State:PA
Practice Address - Zip Code:16935
Practice Address - Country:US
Practice Address - Phone:570-376-3831
Practice Address - Fax:570-376-2370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030004910001Medicaid
PA1030004910001Medicaid
PA390932Medicare PIN